Double Eyelid Surgery

(Asian Eyelid Surgery)


The Asian eyelid is different from the Caucasian eyelid in many ways, which is why Asian eyelid surgery is so unique.

One of the most frequent mistakes that surgeons have made is trying to westernize the eyelids in Asian patients resulting a very unnatural appearance.

Our surgeon is equipped with expertise in eyelid surgery to provide Asian patients with naturally appearing eyelids. Asian individuals also often seek the “double eyelid fold” procedure, which gives the upper eyelid a visible crease when the eye is open. This change to the upper eyelid makes it easier to apply makeup and is considered to be a desirable aesthetic appearance in many Asian cultures.

More often than not the double fold eyelid surgery is combined if patient is deemed suitable with lengthening of the eyes or a creation of a Mongolian fold. Asian eyes require delicate finesse with the typical epicanthal fold that lies in front of the eye so that proper rejuvenation does not mar the natural beauty of this type of eye.

In the Asian eyelid, the primary goal of surgery is creation of a new crease or enhancement of an inadequately defined, asymmetrical, or unstable crease. Skin and fat removal are minimal, and, in many cases, no fat is removed at all. Instead, the procedure is focused on the re-alignment of youthful internal eyelid structure.

Trying to compare minimal-incision “suture techniques” for crease creation with blepharoplasty becomes even more tenuous. The two operations share no common features.

If a young Asian patient is approached surgically in a manner similar to that used in an aging western patient, the result can appear unnatural and surgical.

Double Eyelid Surgery Incision Technique

Exact surgical technique will vary from surgeon to surgeon depending upon his or her training, experience, and preferences. Likewise, variations in pre-existing patient eyelid-facial anatomy will require a customized approach in each individual.

While our resident surgeon has developed his own personal techniques for achieving different lid heights and shapes based upon a number of variables considered both pre-operatively, and intra-operatively, what follows below is a simplified overview of general principles.

Local anaesthesia with light sedation is preferred so that the surgeon can verify the shape and position of the eyelid and crease during surgery by asking the patient to open and close his or her eyes.

Incisional Technique

Because Asian skin is said to be “more reactive,” incisions are best made with a scalpel instead of the laser to minimise scarring.

The skin is incised with a scalpel at a height dictated by measurements of certain existing anatomical landmarks. The incision may be tapered into the epicanthal fold towards the nose (if desired) and/or flared slightly upwards at its outer end (if desired).

Most typically, a small strip of skin above this initial incision is excised using scissors. The amount of skin removed varies depending upon the proposed height of the new crease as well as pre-existing anatomical conditions. In some cases, no skin is removed.

The incision is carried deeper into the eyelid through the orbicularis muscle and orbital septum until the orbital fat is exposed.

Small strips of orbicularis muscle and orbital septum are excised. The amount and location of orbital fat removed has a significant influence on the height, shape, and depth of the new crease.

In most cases, no fat is removed.

The levator aponeurosis (tendon) is identified just beneath the fat. In contrast to an older form of incisional double eyelid surgery known as “anchor blepharoplasty,” the levator aponeurosis is not aggressively exposed or detached from its connection to the tarsal plate, a step that is, in our opinion, unnecessary to formation of a natural appearing crease and invites a higher incidence of serious complications such as ptosis, lid retraction, or peaking of the eyelid margin.

Wound closure employs a “deep-fixation” technique to create an attachment between the aponeurosis and the dermal layer of skin. Following suture removal, internal scars at these points of fixation act much like “spot welds.”

The final crease height and shape are the result of both selective tissue removal and precise internal tissue rearrangement. The operation may be used to create tapered, parallel, lateral flare, and, rarely, semilunar shaped creases or to correct incomplete or multiple creases.

The incisional approach is considered the “gold standard” in Asian double eyelid surgery.


Frequently Asked Questions (FAQs)


1. At how young an age can one undergo cosmetic eyelid surgery?

In the Orient, it is not uncommon for young teenagers (or even pre-teens) to undergo double eyelid surgery. With rare exceptions, the minimum age at which we accept patients for cosmetic surgery is 18. Most of our patients are over age 20.

2. Is there an upper age limit?

From a strictly medical standpoint, no, from an aesthetic standpoint, yes. Because double eyelid surgery is an operation based on the rearrangement of internal structure rather than simple tissue subtraction, it typically works best on younger people with good skin elasticity and stronger internal eyelid anatomy.

In older patients, in those with sagging, thick, or damaged skin, or in those with noticeable facial aging, results after double eyelid surgery are less predictable and may appear less harmonious with the rest of the face.

3. How different will I look afterwards?

That depends on how you look to start, how aggressive you wish to be, and how sensitive you are about your result. If you already possess a natural crease but want it to be higher and more defined, such a result may be achieved without most friends being able to tell you’ve had surgery. On the other hand, if you have a very thick eyelid and absolutely no crease at all, it may take a while to get used to your new lo

4. Will I still look Asian?

Yes. The surgically-created crease more resembles the crease that occurs naturally in over half of the Asian population as opposed to mimicking the shape of the Occidental crease.

5. How much does it costs?

The cost of the Bilateral Double Fold surgery based on a 1.5 hour estimate surgical duration performed in rooms is approximately $3,500. Should the procedure be combined with lengthening it would be an additional $2,000 and an additional for $2,000 for the Mongolian fold. This is an elective procedure, no medicare rebates apply.

Please keep in mind not all patients are alike and some will require a slightly different operation than others. Rest assured, you will receive a specific price quotation during your consultation visit. Our staff are always happy to discuss these matters with you in more detail.

6. Is there patient financing?

Patient financing is completely independent from the clinic. For patients wanting affordable payment plans please apply directly with Total Lifestyle Credit. This facility is subject to approval. Our advice to all patients is to be financially responsible when undertaking finance for elective surgical procedures.

Read more about Blepharoplasty Procedure.

The Esteem Cosmetic Studio website provides general information about cosmetic surgery. General information is not a substitute for professional medical advice and treatment, and should not be accepted in place or in preference to a consultation with a surgeon.
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